The Minister of Health has just submitted to the National Assembly a draft law amending and supplementing several articles of the Health Insurance Law, which includes eliminating the referral procedure for certain rare and critical illnesses, allowing patients to go directly to higher-level specialized hospitals to reduce bureaucratic procedures.
On the morning of October 24th, Minister of Health Dao Hong Lan presented to the National Assembly the draft Law amending and supplementing a number of articles of the Health Insurance Law.
The draft law amends and supplements 40 articles concerning the subjects participating in health insurance, responsibilities for contributions, rights, scope of coverage, organization of health insurance medical examinations and treatments, fund management, and some technical regulations...
Regarding specific content, the Minister of Health stated that the draft Law amending and supplementing the scope of participation and responsibilities for health insurance contributions aims to address shortcomings and ensure consistency with the Social Insurance Law; update the categories of individuals already covered by existing laws and decrees; and add several categories requiring state support to increase universal health insurance coverage.
In particular, the draft Law amending regulations on medical examination and treatment within and outside the designated network (inter-network) is updated according to the technical expertise levels of the 2023 Law on Medical Examination and Treatment; eliminating the referral procedure for some rare and serious illnesses, allowing patients to go directly to higher-level specialized facilities to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the fund.
Specifically, in emergency cases at all medical examination and treatment facilities nationwide: 100% of the costs of inpatient and outpatient medical examination and treatment under health insurance will be reimbursed according to the percentage of the benefit level .
Patients are allowed to go to medical examination and treatment facilities at basic or advanced technical levels in cases of definitive diagnosis and treatment of certain rare diseases, serious illnesses, diseases requiring surgery, or the use of high-tech techniques according to the list of diseases and techniques prescribed by the Minister of Health: 100% of the costs of inpatient and outpatient medical examination and treatment under health insurance will be reimbursed according to the percentage of the benefit level .
For medical examinations and treatments at facilities at the primary healthcare level and basic healthcare facilities that have been assigned to district-level facilities by competent authorities before January 1, 2025: 100% of inpatient and outpatient medical examination and treatment costs covered by health insurance will be reimbursed according to the percentage of the benefit level .
Reviewing this matter, the Chair of the Social Affairs Committee, Nguyen Thuy Anh, stated that the amendment to the regulations on "inter-level medical examination and treatment" aims to expand the scope further, better ensuring the rights of those participating in health insurance.
Accordingly, the health insurance fund will cover medical examinations and treatments as prescribed in cases where patients go to basic or specialized medical facilities on their own in cases of serious or life-threatening illnesses; medical examinations and treatments at primary healthcare facilities and some basic healthcare facilities nationwide; and medical examinations and treatments at specialized healthcare facilities with appropriate schedules.
However, the Chairman of the Social Affairs Committee noted that further assessment is needed regarding the potential impact on the balance of the health insurance fund, as well as the organization and operation of the medical examination and treatment system, including primary healthcare, in order to propose appropriate measures to ensure implementation.
Minister Dao Hong Lan stated that the draft regulations propose expanding the health insurance coverage rate for participants who self-initiate outpatient examinations and treatments at basic and specialized medical facilities that were classified as provincial-level before January 1, 2025, from 0% to 50% of outpatient examination and treatment costs. This will be implemented from July 1, 2026, to allow time for preparing conditions to strengthen the capacity of lower-level facilities and alleviate overcrowding at higher-level facilities.
However, an impact assessment shows that increasing the reimbursement rate risks creating difficulties and challenges affecting the primary healthcare system, causing overload at higher levels, impacting the quality of medical examination and treatment services, and increasing costs from the health insurance fund, with an estimated, but incomplete, amount to over 1,131 billion VND per year.
Patients who have to buy their own medication will have their costs covered directly by health insurance.
The Minister of Health responds to the proposal to consider reducing or subsidizing health insurance contributions.
Source: https://vietnamnet.vn/trinh-quoc-hoi-luat-bhyt-sua-doi-benh-hiem-ngheo-duoc-len-thang-tuyen-tren-2334979.html
Comment (0)